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Andy Lazris
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Curing Medicare: A Doctor's View on How Our Health Care System Is Failing Older Americans and How We Can Fix It (The Culture and Politics of Health Care Work) 1st Edition

by Andy Lazris (Author), Shannon Brownlee (Foreword)
3.9 3.9 out of 5 stars 9 ratings
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Andy Lazris, MD, is a practicing primary care physician who experiences the effects of Medicare policy on a daily basis. As a result, he believes that the way we care for our elderly has taken a wrong turn and that Medicare is complicit in creating the very problems it seeks to solve. Aging is not a disease to be cured; it is a life stage to be lived. Lazris argues that aggressive treatments cannot change that fact but only get in the way and decrease quality of life. Unfortunately, Medicare’s payment structure and rules deprive the elderly of the chance to pursue less aggressive care, which often yields the most humane and effective results. Medicare encourages and will pay more readily for hospitalization than for palliative and home care. It encourages and pays for high-tech assaults on disease rather than for the primary care that can make a real difference in the lives of the elderly.

Lazris offers straightforward solutions to ensure Medicare’s solvency through sensible cost-effective plans that do not restrict patient choice or negate the doctor-patient relationship. Using both data and personal stories, he shows how Medicare needs to change in structure and purpose as the population ages, the physician pool becomes more specialized, and new medical technology becomes available. Curing Medicare demonstrates which medical interventions (medicines, tests, procedures) work and which can be harmful in many common conditions in the elderly; the harms and benefits of hospitalization; the current culture of long-term care; and how Medicare often promotes care that is ineffective, expensive, and contrary to what many elderly patients and their families really want.

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  1. ISBN-10
    1501702777
  2. ISBN-13
    978-1501702778
  3. Edition
    1st
  4. Publisher
    ILR Press
  5. Publication date
    June 14, 2016
  6. Part of series
    The Culture and Politics of Health Care Work
  7. Language
    English
  8. Dimensions
    6.25 x 1 x 9.5 inches
  9. Print length
    264 pages
  10. See all details
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Editorial Reviews

Review

Lazris, a primary care geriatric physician and medical director at facilities for the frail elderly, advocates a minimalist approach to medical intervention for many chronic health problems of advanced age, including dementia. He argues that Medicare's outdated payment rules and assumptions about life expectancy are financing an interminable search for eternal life instead of ensuring that Medicare pays for long-term 'palliative’ care, ideally at home. With an insider’s view, the author does an excellent job of diagnosing pervasive problems in the Medicare system. A fascinating look at how Medicare must change.

― Kirkus Reviews

Review

There is now a sizable choir of American physicians recruited from all corners of the profession whose voices are raised in anguish over the difficulty of practicing medicine according to their conscience. Now Dr. Andy Lazris adds Curing Medicare to the repertoire. It is a compelling lament that is at once strident and compassionate. It earns Lazris a position in the front row of the choir. If only we could fill the pews.

-- Nortin M. Hadler, MD, Emeritus Professor of Medicine and Microbiology/Immunology, University of North Carolina Medical School, author of The Last Well Person: How to Stay Well Despite the Health-Care System and Rethinking Aging:Growing Old and Living Well in an Overtreated Society

Product details

  • Publisher ‏ : ‎ ILR Press; 1st edition (June 14, 2016)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 264 pages
  • ISBN-10 ‏ : ‎ 1501702777
  • ISBN-13 ‏ : ‎ 978-1501702778
  • Reading age ‏ : ‎ 18 years and up
  • Item Weight ‏ : ‎ 1.08 pounds
  • Dimensions ‏ : ‎ 6.25 x 1 x 9.5 inches
  • Customer Reviews:
    3.9 3.9 out of 5 stars 9 ratings

About the author

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Andy Lazris

Andy Lazris

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Andy Lazris is a primary care and geriatrics practitioner in Columbia, Maryland. Alongside his medical career, he is an author, speaker, and advocate for healthcare reform. With a background in history from Brown University and a medical degree from Albert Einstein and the University of Virginia, he combines his knowledge of the past with his passion for healing.

Currently pursuing a Masters in History at the University of Maryland, Andy's unique perspective informs his innovative approach to patient care. In addition to his healthcare work, he has authored captivating fictional books like The Great Stupidity, The Adventures of Yadel the Dreidel, and January 6th and the Millennial Horde to explain the madness of COVID-19.

Customer reviews

3.9 out of 5 stars
9 global ratings

Top reviews from the United States

GEJ12184
4.0 out of 5 stars Excellent discussion of Medicare and the elderly
Reviewed in the United States on September 6, 2016
Verified Purchase
First, I would recommend this book to anyone who has elderly parents or who is approaching old age themselves.

The author discusses the obsessive focus of the US health care system on managing numbers rather than tailoring care to each patient. Increasingly the system rewards statistics and pours Medicare dollars into overly heroic end-of-life treatments. Lazris makes the point that we all die and, as the end approaches, it makes no sense to subject the "frail elderly" (his term) to batteries of tests, over-medication, and invasive procedures in a futile attempt to defeat death. He argues that much Medicare money would be better spent on end-of-life comfort - palliative care, home care, etc. - rather than forcing families to choose between depleting their own resources to keep a loved one at home or have them spend their final days being poked, prodded and tested in a hospital simply because Medicare will only pay for the latter.

Anyway, whether you agree with his views or not, it's an informative book.
4 people found this helpful
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Loren D. Acord
3.0 out of 5 stars complains about the messenger, not the message.
Reviewed in the United States on August 29, 2016
Verified Purchase
Dr.Lazris complains of many of Medicare's policies, and the negative influence they have on the practice of medicine. His complaints would be better directed to the U.S. Congress, or to our society's general attitude about health and medicine.
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Colin R
5.0 out of 5 stars An important book. Very in-depth look at Medicare and ...
Reviewed in the United States on January 28, 2017
Verified Purchase
An important book. Very in-depth look at Medicare and the rest of our health care system as well. Lazris has the education, experience, and background to talk about this with an expertise that few have.
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J. Tyler Resch
4.0 out of 5 stars A realistic view of how Medicare works, and sometimes fails
Reviewed in the United States on October 16, 2016
Verified Purchase
Author Lazris documents, using actual cases in his practice, several improvements needed in Medicare that would make it more realistic while also saving some taxpayers' money. It's well worth a read.
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Spring Texan
5.0 out of 5 stars A discussion we need to have about fixing Medicare
Reviewed in the United States on February 25, 2017
Dr. Lazris has an excellent grip on the realities of geriatric medical care under the Medicare system. His detailed account of how Medicare rules and financing militate toward WORSE care of the elderly -- so that he can usually not in reality do what is best for his patients despite his best efforts -- is much needed. Medicare makes it easy for him to overtreat and overtest and hospitalize, but makes it impossible for him to arrange home assistance or meal delivery and makes it incredibly time-consuming and difficult to get home health visits or an electrified wheelchair for his charges. Another needed reform he doesn't mention because it probably doesn't come into his purview is Medicare's omission of dental care coverage.

Although he's glad Medicare is available to most of the old, he wishes it would take another shape and not push toward "thorough," intensive, and often cruel "care." His criticisms are very well taken and I'd like to see him interviewed on radio and TV shows to continue the discussion.

One real strength of the book is that it is very detailed in how specific Medicare practices such as quality indicators and the "three-night rule" and the associated financing determine the sort of care that is given. He also mentions other bureaucratic practices with an impact on care such as nursing home surveys. [Sometimes his informed jargon is jarring to a non-insider, such as referring to "skilled patients" when he means patients in the "Skilled Nursing Facility" category.]

I have two small criticisms. One is that, as much as I agree with him, he sometimes seemed a little one-sided in his presentation as an advocate. A small, pedantic criticism is that he twice states that ALL Americans over age 65 get Medicare Part A free. This is simply untrue. It depends on work history and a small number of the elderly do NOT qualify (and most who do not cannot afford the expensive premiums) and are generally not covered by Medicare Part A. This may not be a big deal in the big picture but it is typical of our fragmented system and is a big deal for some of those who do not qualify.
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Peter D. Tillman
5.0 out of 5 stars Required reading for those with aging parents, and those who are getting old themselves....
Reviewed in the United States on December 30, 2016
The take-home: Less is more, when it comes to medical care for the elderly. Pretty much required reading for those with aging parents, and those who are getting old themselves.... The author, a geriatric GP, talks mostly about the perils of over-treating frail elders who are reaching (or over) the limits of independent living. Many medications' side-effects outweigh their benefits for frail old people, and admission to hospital is very often their death sentence. Dr. Lazris relates a case early in his career, an active 90-year old farmer with extremely high blood pressure. Dr. Lazris prescribed medication, his patient started taking it, and was dead within a week. On thinking it over, he thinks the man had narrowed arteries, and his body was compensating by raising the pressure. When the medication lowered his pressure, he died. Oops.

Medicare spends roughly a quarter of its budget on patients in their last year of life—a proportion that has remained steady for decades. "The operations were a success, but the patients died." Medicare spending in 2015 exceeded $600 billion.

So it's pretty obvious there are serious problems here, many relating to top-down, one-size-fits-all Medicare regulations, and this is widely known in the medical business. It's also clear that there are major financial beneficiaries from the high spending: Hospitals, attending physicians, and drug companies. Which suggests why Medicare has been slow to pay for less-expensive palliative and home care for frail old people. Which is what most of the patients actually want. But to get Medicare to pay, they often must go to the hospital, often to lose their lives in pain and indignity. Catch-22.

Cross-ref to the first edition with 22 customer reviews, averaging 4.8/5 stars: Curing Medicare: One doctor's view of how our health care system is failing the elderly and how to fix it.

Link to sample chapters and synopsis at the first comment, per house rules.

Happy reading--
Peter D. Tillman
2 people found this helpful
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